ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with COMISA. (...) We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

Co-morbidity of schizophrenia and autism is low because interpersonal concerns of schizophrenic patients presuppose developmental achievements that are absent in autism. Autism may arise if primary anxiety is not overcome at a key developmental stage by affective synchronisation between infant and caregiver. Schizophrenic patients will have learned to regulate primitive anxiety by affectively attuning to narrow social networks but remain highly vulnerable to exclusion from larger groups.

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents’ perceptions of their child’s projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness of (...) parental refusal based upon an infant’s projected quality of life. (shrink)

Treatment of military-related posttraumatic stress disorder is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have sought VA health care services for PTSD. This recent increased need (...) for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority. (shrink)

Ontologies are being developed throughout the biomedical sciences to address standardization, integration, classification and reasoning needs against the background of an increasingly data-driven research paradigm. In particular, ontologies facilitate the translation of basic research into benefits for the patient by making research results more discoverable and by facilitating knowledge transfer across disciplinary boundaries. Addressing and adequately treating mental illness is one of our most pressing public health challenges. Primary research across multiple disciplines such as psychology, psychiatry, biology, neuroscience and pharmacology (...) needs to be integrated in order to promote a more comprehensive understanding of underlying processes and mechanisms, and this need for integration only becomes more pressing with our increase in understanding of differences among individuals and populations at the molecular level concerning susceptibility to specific illnesses. Substance addiction is a particularly relevant public health challenge in the developed world, affecting a substantial percentage of the population, often co-morbid with other illnesses such as mood disorders. Currently, however, there is no straightforward automated method to combine data of relevance to the study of substance addiction across multiple disciplines and populations. In this contribution, we describe a framework of interlinked, interoperable bio-ontologies for the annotation of primary research data relating to substance addiction, and discuss how this framework enables easy integration of results across disciplinary boundaries. We describe entities and relationships relevant for the description of addiction within the Mental Functioning Ontology, Chemical Entities of Biological Interest Ontology, Protein Ontology, Gene Ontology and the Neuroscience Information Framework ontologies. (shrink)

Given research and public interest for conditions related to an extended lifespan, we addressed the questions of what matters and what matters most for subsequent survival past age 80. The data was drawn from the population-based and multidisciplinary Swedish OCTO Twin Study, in which a sample consisting of identical and same-sex fraternal twin pairs, followed from age 80 until death, provided detailed data on health, physical functioning, life style, personality, and sociodemographic conditions. Information concerning date of birth and death were (...) obtained from population census register. We estimated heritability using an ACE model and evaluated the role of multiple predictors for the mortality-related hazard rate using Cox regression. Our findings confirmed a low heritability of 12%. As expected, longer survival was associated with being a female, an apolipoprotein E e4 allele non-carrier, and a non-smoker. Several diseases were found to be associated with shorter survival as well as certain health conditions. Stronger grip and better lung function, as well as better vision, and better cognitive function was related to longer survival. Social embeddedness, better self-evaluated health, and life-satisfaction were also significantly associated with longer survival. After controlling for the impact of comorbidity, functional markers, and personality-related predictors, we found that sex, cerebrovascular diseases, compromised cognitive functioning, self-related health, and life-satisfaction remained as strong predictors. Cancer was only associated with the mortality hazard when accounting for other co-morbidities. The survival estimates were mostly in anticipated directions and contained effect sizes within the expected range. Noteworthy, we found that some of the so-called “soft-markers” remained strong predictors, despite a control for other factors. For example, self-evaluation of health and ratings of life-satisfaction provide additional and valuable information. (shrink)

Background: Double degrees in nursing and midwifery have evolved in Australia as a proposed solution to possible impending shortages of qualified midwives in the healthcare workforce. The double degree is seen as a more acceptable option in non-metropolitan areas in particular. Concern has been expressed however, about dilution of midwifery philosophy and graduates opportunities in respect of future clinical practice. Aim: This study aimed to provide a better understanding of motivations and intentions of students who undertake the Bachelor of Nursing (...) Science/Bachelor of Midwifery double degree. Methods: A cross-sectional survey design was employed at four universities that offered double degrees in nursing and midwifery in three states of Australia. Students enrolled in first and fourth year of a double degree and graduates of a double degree were invited to complete an online survey comprised of Likertscales and items requiring free text responses. Quantitative data was analysed using SPSS and thematic analysis was used to analyse the qualitative data. Findings: Participants indicated a clear preference for midwifery as a career with this preference increasing for each cohort at each stage of study. Discussion: Primary reasons for selecting a double degree were perceived increased opportunity for employment and use of nursing skills to enhance midwifery practice in a population with growing co-morbidities. A strong identification with midwifery philosophy and identity was also demonstrated.Conclusion: An understanding of motivations and career intentions of students undertaking double degree studies can inform future program development and workforce planning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Am Not Sure?Paul E. LevinIt was a beautiful Friday morning, a few weeks into the summer. My schedule appeared lighter than usual and I even envisioned leaving work a bit early. Maybe a challenging bike ride before dinner. I was sitting in the chairman’s office having our weekly meeting. One of our junior faculty members called... he needed help. He was on call and a 32–year–old pregnant woman (...) with a displaced femoral neck fracture had just been transferred to our emergency department (ED). Ms. B tripped in her kitchen last evening. She was unable to stand and was brought to the local ED by ambulance.My colleague was concerned that he wouldn’t be able to successfully reduce the fracture. The long–term prognosis of the hip joint depended on a successful reduction of the femoral neck fracture. In addition, there was an ongoing debate in the orthopaedic literature related to the urgency of operative care to prevent osteonecrosis of the femoral head. I reviewed the x–rays, didn’t anticipate a problem and let him know that I would come to the operating room (OR) to assist. “No”, he responded, “I am not comfortable caring for this patient”. I immediately left the office, went to the hospital and assumed care of the patient. Clearly, my plans for a bike ride were gone, but I had the opportunity to help a woman in need of expert orthopaedic care.Ms. B had been admitted to the obstetrical service. She was a 32–year–old woman of Haitian descent who had recently immigrated to the United States. She had very limited English comprehension and her primary spoken languages were French and Creole. She was alone, in a hospital in a foreign country. She was 24 weeks pregnant with her first child and had no other co–morbidities. Her pregnancy had ben progressing uneventfully.When I first met Ms. B she was lying on a stretcher in an observation unit on the obstetrical floor. She appeared frightened. Two orthopaedic residents were present and obtaining consent for surgical repair of the hip. In their minds there was nothing to discuss, the patient had a displaced femoral neck fracture and needed to have surgery immediately. In their minds, no other options were available and obtaining consent would be straightforward. I introduced myself, sat down on a lab stool by the bed and began a conversation. I needed to meet the patient, understand who she was and discuss treatment. I am not sure that obtaining an informed consent is ever “straightforward” when [End Page 14] a doctor is explaining to a patient that they require emergency surgery. This discussion surely would not be easy or straightforward.We utilized a telephone interpretation service. Every question and response required the transfer of the handset between the patient and physician. Ms. B was in pain and frightened. She immediately expressed concern about her pregnancy and her baby. I arranged for her to meet all of the physicians who would possibly be involved in her care and the care of her baby. Each consultant could explain their area of expertise and potential involvement in the care of Ms. B and her child. She met and had an opportunity to talk with the obstetrician on call, a maternal fetal medicine (MFM) fellow and a neonatologist. I supplied the orthopaedic information. I explained the severity of the injury, the risks of osteonecrosis either with or without surgery as well as concerns over non–union and traumatic arthritis of the hip. Undoubtedly, in a healthy 32–year–old woman who wasn’t pregnant, early surgical intervention would be the most appropriate management in hopes of preserving a normal hip joint. We also discussed the possibility of treating her without surgery. She would be administered pain medication, which were known to be safe during pregnancy, and allowed to begin to ambulate with a walker or crutches. I explained potential problems without surgery and what options would be available to treat any problems that developed with her hip after the child was born. Of course, hip fractures in pregnant woman are very rare, and as a result treating a... (shrink)

Because an organization member’s degree of cognitive moral development (CMD) can be expected to influence his or her decisions and behaviour, in this paper we investigate the idea that that employees might prefer to supervise, work with, or work under others of particular levels or stages of CMD. We surveyed undergraduate business students in order to identify typical CMD preferences for co-workers and test preliminary hypotheses concerning possible influences on those preferences. Majorities of subjects expressed preferences for conventional level work (...) peers and subordinates but postconventional superiors, which could augur a lack of congruence between what subordinates typically desire of their superiors and how those superiors are likely to actually behave. (shrink)

We trace the difference between the ways in which apes and humans co–operate to differences in communicative abilities, claiming that the pressure for future–directed co–operation was a major force behind the evolution of language. Competitive co–operation concerns goals that are present in the environment and have stable values. It relies on either signalling or joint attention. Future–directed co–operation concerns new goals that lack fixed values. It requires symbolic communication and context–independent representations of means and goals. We analyse these (...) ways of co–operating in game–theoretic terms and submit that the co–operative strategy of games that involve shared representations of future goals may provide new equilibrium solutions. (shrink)

Being more than mere passive objects used at human will, technologies co-determine the values and structures that shape the EU agricultural system. Technologies actively shape human interpretation, human action and co-shape our moral standards and routines. It is therefore important to account for the moral significance of agricultural technologies when characterising the structures in place within EU agriculture as well as when trying to understand why a particular agricultural technology is favoured or strongly opposed. From this perspective on technology, an (...) interesting question to pose, is how, within their current use context, genetically modified crops mediate human interpretation and human practice? This technology is of particular interest, because after more than 30 years, the debate on GM crops is still profound and highly polarised within EU society. Yet, too often, this debate is devalued as being irrational or irrelevant, while we show in this article, based on a technological mediation analysis, how ethical concerns about agricultural practices have co-evolved with the technological development of GM crops. This qualifies public debate on GM crops in the EU as both legitimate and relevant, as, from this perspective on technology, it can be seen as an important way to both characterise and discuss how EU agriculture is and should be organised. Analysing technology in terms of the myriad ways in which it mediates the relationship between humans and their world, further allows us to make some suggestions about how to broaden the ongoing EU discussion beyond the current dichotomous Yes/no framing. (shrink)

To enlarge the discussion of scientific responsibility for research integrity, this paper offers two historico-philosophical observations. First, in the broad history of ideas, modern ethics replaces social role responsibility with appeals to abstract principles; by contrast, discussions within the scientific community of responsibility for research integrity constitute a rediscovery of the continuing vitality of role responsibility. This is a rediscovery from which philosophy itself may benefit. Second, within the context of scientists’ concerns, the idea of role responsibility has undergone (...) significant evolution from “collective responsibility” to the notion of responsibility resting with a “trans-scientific community.” Further challenges nevertheless remain in order to relate scientific role responsibility for scientific integrity to the relationship between science and society. To promote a notion of integrity not just in science but in the science-society relationship, it may be useful to think in terms of a “co-responsibility” for scientific integrity. (shrink)

The co-instantiation thesis is pivotal to a significant solution to the problem of causal exclusion. But this thesis has been subject to some powerful objections. In this paper, I argue that these difficulties arise because the thesis lacks the necessary metaphysical framework in which its claims should be interpreted and understood. Once this framework is in place, we see that the co-instantiation thesis can answer its critics. The result is a rehabilitated co-instantiation solution to the troubling problem of causal exclusion. (...) But questions remain concerning the viability of certain of its applications. (shrink)

Empirically-informed philosophy of mind (EIPM) has become a dominant research style in the twenty-first century. EIPM relies on empirical results in various ways. However, the extant literature lacks an empirical description of how EIPM philosophers rely on empirical results. Moreover, though EIPM is essentially a form of cross-disciplinary research, it has not been analyzed as cross-disciplinary research so far. We aim to fill the above two gaps in the literature by producing quantitative and qualitative descriptions of EIPM as a kind (...) of cross-disciplinary research. Our descriptions aim to enable metaphilosophers to evaluate EIPM methodologically and epistemically. Our analyses use co-citation and categorization analyses informed by the literature on interdisciplinarity. We present five sets of descriptions and identify the three most common types of cross-disciplinary interactions in EIPM. The resulting descriptions enable us to locate two metaphilosophical challenges for EIPM philosophers. One concerns how they should incorporate empirical results in different disciplinary contexts, and the other concerns which theoretical virtue(s) they should aim for when tinkering with scientific theories. (shrink)

This article examines the ontology and politics of Peter Sloterdijk's Spheres trilogy, focusing in particular upon the notion of microspherical enclosure explicated in the first volume of this series. Noting Sloterdijk's unusual alignment of his philosophy with media theory, three main contentions are put forward. Firstly, that Sloterdijk's reconfiguration of Heidegger's fundamental ontology represents a largely unacknowledged renunciation of the primacy of Being-towards-death in the authentic existence of Dasein, foregrounding instead an originary co-belonging between mother and child. Secondly, that Sloterdijk (...) borrows from media theory a concern regarding the facticity of all communication, grounding philosophical discourse in the determinate locality of its origin, but does so while exalting a pre-natal communicative immediacy that would seem to disparage the everydayness of Dasein. Finally, that Sloterdijk's oft-justified scepticism regarding globalization often retreats into an anti-cosmopolitanism that, in its nostalgia for the comfort, security and immediacy of the matrixial co-belonging, evinces a covert but potentially noxious politics of exclusion. (shrink)

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from (...) worries that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed. (shrink)

A general account of the Confucian self as either collectivist or relational requires careful examination. This article begins with the major textual resources of the Confucian tradition and then compares this idea of moral expansion with Deweyan ideas of the self and community. By parsing key Confucian terms that comprise the meaning of “being together” and “mutual association,” the author argues that Confucian selves and individuals are fundamentally contextually creative. By comparing the Confucian idea of family with the Deweyan notion (...) of community, the author further supports his argument that the Confucian self is always co-creative with others. Despite the fact that Confucian ethics has long been considered either a kind of virtue ethics or a kind of role ethics, the author argues that Confucian ethics is better viewed as a kind of co-creative ethics, which stems from an ethical theory concerning the co-creative self and other. (shrink)

E-Co-Affectivity is a philosophical investigation of affectivity in various forms of life: photosynthesis and growth in plants, touch and trauma in bird feathers, the ontogenesis of human life through the placenta, the bare interface of human skin, and the porous materiality of soil. Combining biology, phenomenology, Ancient Greek thought, new materialisms, environmental philosophy, and affect studies, Marjolein Oele thinks through concrete, living places that show the receptive, responsive power of living beings to be affected and to affect. She focuses on (...) these localized interfaces to explain how affectivity emerges in places that are always evolving, creative, porous, and fluid. Every interface is material, but is also "more" than its current materiality in co-creating place, time, and being. After extensively describing the effects of the milieu and community within which each example of affectivity takes place, in the final chapter Oele adds a prescriptive, ethical lens that formulates a new epoch beyond the Anthropocene, one that is sensitive to the larger ecological, communal concerns at stake. (shrink)

(1) This is Part 2 of the semantic theory I call TM. In Part 1, I developed TM as a theory in the analytic philosophy of language, in lexical semantics, and in the sociology of relating occasions of statement production and comprehension to formal and informal lexicographic conclusions about statements and lexical items – roughly, as showing how synchronic semantics is a sociological derivative of diachronic, person-relative acts of linguistic behavior. I included descriptions of new cognitive psychology experimental paradigms which (...) would allow us to precisely measure the two constituents of semantics – meaning and reference – both at the level of individual speech acts and at the level of societal convergences, i.e. at both the token and type levels. -/- (2) In the Introduction, I recapitulate the arguments of Part 1. The Introduction also develops some analytic philosophical and lexical semantics themes not discussed in Part 1. -/- (3) After the Introduction, I present neural TM (nTM) as a theory of the neural mechanisms and processes which give rise to these person/occasion-relative acts of linguistic behavior. I develop nTM at three levels, the first two of which describe linguistic/semantic functions independently of their cortical locations. At the first level, I describe individual word-to-word and word-to-object connections. At the second level, I describe the corresponding structuralist networks of which they are the individual components. At this level, I introduce some key linguistic concepts of TM – its graded meaning, reference, and generalization sets, and the types of statements which express various levels of word-to-word and word-to-object relationships among lexical items which, because of the constraints they impose on the use of those lexical items in statements we produce and comprehend, are concepts. This constitutes the second structural level of nTM. -/- (4) At the third level, I associate the non-localized structures of the previous levels with cortically located neural structures and with the fasciculi that connect them. I distinguish neural areas in which primary (phonetic) and secondary (orthographic) lexicons are stored in long-term memory. I also describe the embodied concepts which co-exist in the anterior temporal lobes with the images they lexicalize. These concepts are often said to name physical objects and their features, although what they in fact name are kinds of physical objects and features. I describe how conceptual constraints and referential constraints interact to channel our intentions to say how things are into statements which are semantically well-formed, and which consequently successfully communicate information. -/- (5) Following this presentation of nTM, I examine five prominent neural semantic theories. I point out what is wrong with each of them as far as their explanations of semantics are concerned, and I also indicate how nTM can replace the “semantic cores” of those theories. -/- (6) The two basic mistakes made by neuroscience semantic theories, as I will explain, are (i) that all but one of them regard semantics as a matter of the association of words with perceptual images, and of generalizations from those associations; and (ii) that they all rely on an unspecified set of neural structures which purportedly encode the meaning of concepts in abstraction from their phonological and orthographic forms. nTM maintains, in contrast, that there are no abstract neural representations of semantic content. Neural constraints on our linguistic behavior, especially on our ascriptive and co-ascriptive use of words, express the semantic constraints on those words which make them concepts. That is the semantic content of words. -/- (7) I next consider several results from neuroscience experimental data which have been given one interpretation by one or another of the standard neurosemantic theories, but to which nTM gives a different interpretation. I include several predictions which I have found neither confirmed nor disconfirmed in the experimental neuroscience literature. -/- (8) After a concluding section in which I summarize the major changes to neurosemantic theory introduced by TM, and the analytic philosophy of language and lexical semantics contexts within which TM is situated, there follows an appendix in which I discuss neural net AI, and make some recommendations for implementing nTM in silicon. (shrink)

The paper presents the sources and the development of the medieval doctrine of transcendentals. In Aertsen's opinion transcendental philosophy of the Middle Ages differs considerably from the ontological doctrine of the Ancients as well as from the modern theory referring to the sphere of cognition. The beginnings of the medieval doctrine of the transcendentals were inspired mostly by considerations concerning primary conceptions of human mind included in Avicenna's "Metaphysica". Furthermore, they were connected with the Aristotelian idea of science, the Boethian (...) axiomatic method of "common conceptions of the soul", and theologians' interest in the horizon of human intellectual knowledge. Beside the Aristotelian-Avicennian reduction to the most universal predicate Albert the Great acknowledge another reduction (originating from the Christian-Neoplatonic tradition): reduction to the first cause. In his opinion, these two resolutions are complementary to each other. In the philosophy of Thomas Aquinas, transcendentals are most fundamental insofar as they are the foundations of theoretical and practical science. The principle of contradiction – considered as the beginning of theoretical science – rests on the understanding of "being", and the first precept of natural law is founded on "the good". The development of the doctrine of the transcendentals in 13th century aloows to call the period "the second beginning of metaphysics" – since it changes the understanding of the proper subject of First Philosophy. In Albert the Great, for example, matephysics ceases to be the science of the divine, and becomes the science concerning what is first and the most fundamental – "being-as-being". In St. Bonaventure's philosophy, the doctrine of the transcendentals undergoes a theologizing transformation: that, which is first in the cognitive order is, at the same time, first ontologically. For Bonaventure, the latter "first" is God. (shrink)

Public health is concerned with how to improve the population’s health. At times, though, actions to improve the community’s health may collide with individual civil rights. For example, a public health response to a bioterrorism attack, such as smallpox, may require relaxing an individual’s due process protections to prevent the smallpox from spreading. This tension lies at the heart of public health policy. It also must be considered in discussing the concept of human rights in health.Proponents of incorporating the concept (...) of human rights in health emphasize the importance of both individual rights and collective rights. They argue that observing human rights is not only consistent with broad public health goals, but necessary to their attainment. To many human rights advocates, the concept is not limited to protecting against governmental intrusion. Accordingly, they emphasize the government’s obligation to promote attainment of human rights by, for instance, providing adequate health care. (shrink)

Public health is concerned with how to improve the population’s health. At times, though, actions to improve the community’s health may collide with individual civil rights. For example, a public health response to a bioterrorism attack, such as smallpox, may require relaxing an individual’s due process protections to prevent the smallpox from spreading. This tension lies at the heart of public health policy. It also must be considered in discussing the concept of human rights in health.Proponents of incorporating the concept (...) of human rights in health emphasize the importance of both individual rights and collective rights. They argue that observing human rights is not only consistent with broad public health goals, but necessary to their attainment. To many human rights advocates, the concept is not limited to protecting against governmental intrusion. Accordingly, they emphasize the government’s obligation to promote attainment of human rights by, for instance, providing adequate health care. (shrink)

Previous work has shown that concerns of breast cancer patients after finishing radiotherapy are responsive to conversations with radiographers during the treatment period. This study seeks to further understand radiographer and patient experiences, determine shared priorities for improvement in clinical interaction and develop communication guidelines and training to help radiographers support patients.Methods: Using the principles of Experience-Based Co-Design, semi-structured interviews were held with N = 4 patients and N = 4 radiographers, followed by feedback events to validate findings. Patients (...) and radiographers exchanged experiences in a joint co-design session, agreed with shared priorities and generated ideas for further support. A survey was conducted for process evaluation. To scale up findings, UK-wide representatives from patient networks and radiographers and managerial staff provided consultative input utilizing an iterative, adaptive procedure.Results: Radiographers expressed a need for support with “difficult conversations,” especially those on Fear of Cancer Recurrence, and their appropriate management. Important pointers for reassuring communication were identified, including: being treated like a person, knowing what to expect, and space to ask questions. The co-design process was rated positively by both staff and patients. Thematic collation of findings and mapping these on literature evidence resulted in the “KEW” communication guidelines for radiographers: Know, Encourage, Warmth. National stakeholder consultations validated and helped fine-tune the training model. The resulting training package, included: trigger videos, a simulated patient scenario and interactive handouts on fears of cancer recurrence and the patient pathway.Conclusions: The co-design process captured good practice to help standardize quality in empathic communication in the radiotherapy service. The resulting KEW: Know, Encourage, Warmth guidelines, and training package are user-centered as well as evidence-based. Supplementing single-site co-design with national consultative feedback allows for the development of interventions that are relevant to the clinical practice, even in detail, and helps to generate appropriate buy-in for roll out on a wider scale after evaluation.Trial Registration:www.ClinicalTrials.gov ID: NCT03468881. (shrink)

All human civilizations have thought that the world was made of sky above and the Earth below. All except one. For the Greeks, the Earth was a rock floating in space, and under the earth there was no ground, no turtles, nor the gigantic columns of which the Bible speaks. How did the Greeks understand that the Earth is suspended in nothingness? Who understood this and how? It is this unique "scientific revolution" of Anaximander of which the author speaks, which (...) Karl Popper called "one of the most daring ideas, revolutionary and portentous in the entire history of human thought" The concern is with the conflict that was opened, still burning, with the nature of scientific thought, its critical and rebellious character, the force with which it subverts the order of things and our image of the world of scientific knowledge, and the highly effective "error" at the same time --as we teach physics in the twentieth century. Speaking of Anaximander, the author invites us to reflect on what his ideas mean to the scientific revolution opened by Einstein. (shrink)

The coupling of 'self and other' as well as the issues regarding intersubjectivity have been central topics in modern Japanese philosophy. The dominant views are critical of the Cartesian formulation , but the Japanese philosophers drew their conclusions also based on their own insights into Japanese culture and language. In this paper I would like to explore this theme in two of the leading modern Japanese philosophers - Kitaro Nishida and Tetsuro Watsuji . I do not make a causal claim (...) that Japanese culture or language was responsible for these thinkers' philosophy, although without a doubt they were strong influences. The point rather is to show an interesting convergence of concerns regarding the fundamental nature of the relation between the self and others across different cultures and intellectual traditions, and to clarify further the ontological structure of the self-other relation. After the examination, the thesis I would like to defend here is the following: Intersubjectivity is indeed a condition, rather than an accident, of the structure of lived experiences as such but this relation also requires at the same time the recognition that the Other must remain a true negation-in-relation to the self. Let me first turn to Watsuji, although chronologically he was 20 years junior and was a student of Nishida, since Watsuji's phenomenology deals more directly with the topic of intersubjectivity. I will then turn to Nishida's broader ontological considerations. (shrink)

The general topic of my remarks concerns the place, or basho in Japanese, of transcontinental philosophy within the context of the Society for Phenomenology and Existential Philosophy and the philosophical profession in general. I introduced the term transcontinental when as director of the thirty-fifth Collegium Phaenomenologicum in 2010 I formulated the theme of that year's meeting: "Transcontinental Philosophy: Interpreting Philosophy Across Borders and Idioms." Marking what was a historic first for the Collegium Phaenomenologicum—namely, engaging non–North American and European perspectives (...) on continental philosophy—the neologism transcontinental philosophy signified not only the growing global reach but... (shrink)

Meet Tega. Blue, fluffy, and AI-enabled, Tega is a relational robot: a robot designed to form relationships with humans. Created to aid in early childhood education, Tega talks with children, plays educational games with them, solves puzzles, and helps in creative activities like making up stories and drawing. Children are drawn to Tega, describing him as a friend, and attributing thoughts and feelings to him ("he's kind," "if you just left him here and nobody came to play with him, he (...) might be sad"). Scholars and members of the public alike have raised the alarm about relational robots, worrying that the relationships that people, and especially children, form with such robots are objectionably inauthentic. We, members of an interdisciplinary team that developed and studies Tega, make this inauthenticity worry precise and offer practical recommendations for addressing it. We distinguish two kinds of (in)authenticity -- inauthenticity as unreality, and inauthenticity as deception -- arguing that neither is just what others have thought it is. With our distinction in hand, we argue that the authenticity concern can be met only through co-design methods -- methods that give stakeholders of all kinds (e.g. parents, educators, and children themselves) a genuine say in how relational robots are built. (shrink)

We discuss our surgical philosophy concerning the subtle interplay between the size of the surgical margin taken and the resultant morbidity from ablative oncological. procedures, which is ever more evident in the treatment of head and neck malignancy. The extent of tissue resection is determined by the "trade off" between cancer control and the perioperative, functional and aesthetic morbidity and mortality of the surgery. We also discuss our dilemmas concerning recent minimally invasive endoscopic microsurgical. techniques for the trans-oral laser removal. (...) or co-ablation of aero-digestive tract tumours, which result in a minimal. surgical margin of oncological clearance. By a process of inductive argument as to the nature of the surgical margin, we consider whether the risks of taking a lesser margin with adjuvant therapy is justified by the attendant gain in reduced surgical morbidity and the possible costs in tumour control. (c) 2006 Elsevier Ltd. All rights reserved. (shrink)

On Tyranny, by Leo Strauss and Alexander Kojève, is now available in Italian. The article examines the debate between the two philosophers, focussing primarily on their respective views of political philosophy and the opposition between ancients and moderns concerning such issues as the role of luck, the gap between theory and practice, and whether or not history is meaningful, teleologically oriented, able to prove political theory or, on the contrary, itself subject to theoretical judgment. The author explains how the debate (...) centres around two fundamentally different views of the relationship between philosophy and love of recognition. While for Kojève subjective certainty becomes knowledge only when widely recognized , Strauss, whose starting points are Xenophon’s and Plato’s views on the relationship between love of honour and philosophy, maintains that recognition is no guarantee of truth, and philosophy, in its most authentic form, is sceptical or zetetic. (shrink)

This study concerned the role of gestures that accompany discourse in deep learning processes. We assumed that co‐speech gestures favor the construction of a complete mental representation of the discourse content, and we tested the predictions that a discourse accompanied by gestures, as compared with a discourse not accompanied by gestures, should result in better recollection of conceptual information, a greater number of discourse‐based inferences drawn from the information explicitly stated in the discourse, and poorer recognition of verbatim of the (...) discourse. The results of three experiments confirmed these predictions. (shrink)

From its humble beginnings in 1961, the Society for Phenomenology and Existential Philosophy has emerged as the second largest society of philosophers in the West. From a near-impromptu gathering of a couple dozen participants, those who now claim SPEP membership number into the thousands, with one recent meeting having around 750 registered participants. The fact of its size and its diversity provokes several important questions concerning the identity and orientation of SPEP—questions that are as much philosophical as they are practical: (...) Is SPEP a blanket umbrella organization, or does it have a direction and/or sense? What implications do the latter have for its place as a philosophical organization .. (shrink)

What does God know about future contingents? – according to some fourteenth-century English thinkers The paper is concerned with the problem of God’s knowledge aboutfuture contingents, which has raised many doubts connected with the incompatibility of certainty and necessity of God’s knowledge and contingency of future events, or, even more, with the incompatibility of God’s precognition causing necessary events with human’s free choice guaranteed by his free will. From the very beginning of the Middle Ages theologians tried to find solutions (...) to these questions, but—in my opinion—the most interesting ones were those expressed by John Duns Scotus. This paper presents mostly the theories of some English thinkers who were active at Oxford Universityin the 14th century and who criticized or agreed with Scotus’s ideas. They introduced new terminology and clarified particular problems initiating original logico-theological debates, in which the problem of God’s action with regard to His potentiaabsoluta et ordinataplayed the main role. Keywords: Middle Ages theologians, English thinkers, God’s knowledge, future contingents. (shrink)

The present study intends to demonstrate that there is no logical-formal inconsistency in the Christian Trinity. However, the demonstration requires specific tools, other than those of classical logic. There are many older or newer attempts that try to remove the thesis of the inconsistency of the Christian Trinity. There is often a call for mathematical tools. As far as we are concerned, we will appeal to co -inherence and the nesting relationships specific to the Christian Trinity, as they appear especially (...) in Augustine’s work. We advance the hypothesis that Augustine's metaphor "heaven of heavens" has a foundational role in the logical plane of explanation. In this sense, Augustine points out that in the "heaven of heavens", reason does not know "in part", but it knows everything suddenly, entirely, as in a totality. This totality with a founding role functions as a principle, which we can call the principle of free totality. But the co -belonging of entities in the free and founding totality also expresses co -inherence. Divine persons are an emanation of God. That is why we are talking about co -inherence. The "co" particle points out that the starting point is in the free totality of God, and that this totality logically precedes the rest of the process. Thus, we can consider the term "the Christian Trinity" as a nested term, as co -habitation. The totality of God is not a generalization in the spirit of the Aristotelian abstraction, but rather a particularity, a "personalization" that does not cancel the individual, but it highlights in instantiation. In this sense, the Christian God is not an abstraction, but a divine Being in three persons, in whom He instantiates. The logic of this process is the one of vagueness. (shrink)

Understanding the link between brain evolution and the evolution of distinctive features of modern human cognition is a fundamental challenge. A still unresolved question concerns the co-evolution of tool behavior (i.e., tool use or tool making) and language. The shared neurocognitive processes hypothesis suggests that the emergence of the combinatorial component of language skills within the frontal lobe/Broca's area made possible the complexification of tool-making skills. The importance of the frontal lobe/Broca's area in tool behavior is somewhat surprising with (...) regard to the literature on neuropsychology and cognitive neuroscience, which has instead stressed the critical role of the left inferior parietal lobe. Therefore, to be complete, any version of the shared neurocognitive processes hypothesis needs to integrate the potential interactions between the frontal lobe/Broca's area and the left inferior parietal lobe as well as their co-evolution at a phylogenetic level. Here, we sought to provide the first elements of answer through the use of the massive deployment framework, which posits that evolutionarily older brain areas are deployed in more cognitive functions (i.e., they are less specific). We focused on the left parietal cortex, and particularly the left areas PF, PGI, and anterior intraparietal (AIP), which are known to be involved in tool use, language, and motor control, respectively. The deployment of each brain area in different cognitive functions was measured by conducting a meta-analysis of neuroimaging studies. Our results confirmed the pattern of specificity for each brain area and also showed that the left area PGI was far less specific than the left areas PF and AIP. From these findings, we discuss the different evolutionary scenarios depicting the potential co-evolution of the combinatorial and generative components of language and tool behavior in our lineage. (shrink)

Understanding the link between brain evolution and the evolution of distinctive features of modern human cognition is a fundamental challenge. A still unresolved question concerns the co-evolution of tool behavior (i.e., tool use or tool making) and language. The shared neurocognitive processes hypothesis suggests that the emergence of the combinatorial component of language skills within the frontal lobe/Broca's area made possible the complexification of tool-making skills. The importance of the frontal lobe/Broca's area in tool behavior is somewhat surprising with (...) regard to the literature on neuropsychology and cognitive neuroscience, which has instead stressed the critical role of the left inferior parietal lobe. Therefore, to be complete, any version of the shared neurocognitive processes hypothesis needs to integrate the potential interactions between the frontal lobe/Broca's area and the left inferior parietal lobe as well as their co-evolution at a phylogenetic level. Here, we sought to provide the first elements of answer through the use of the massive deployment framework, which posits that evolutionarily older brain areas are deployed in more cognitive functions (i.e., they are less specific). We focused on the left parietal cortex, and particularly the left areas PF, PGI, and anterior intraparietal (AIP), which are known to be involved in tool use, language, and motor control, respectively. The deployment of each brain area in different cognitive functions was measured by conducting a meta-analysis of neuroimaging studies. Our results confirmed the pattern of specificity for each brain area and also showed that the left area PGI was far less specific than the left areas PF and AIP. From these findings, we discuss the different evolutionary scenarios depicting the potential co-evolution of the combinatorial and generative components of language and tool behavior in our lineage. (shrink)

This articles concerns the compatibility of orthonomy (making the right choices) and autonomy (making one’s own choices). On the one hand we have the experience that we do not just want to govern ourselves, but that we want to do so rightly. the other hand, it seems that the very fact that our choices are responsive to reasons is insufficient to explain why making these choices adds up to leading a life of one’s own. Iit is argued that we (...) can develop a viable view on the co-realisation of autonomy and orthonomy by using the concept of a concern which is closely linked to the concept op caring. (shrink)

Background Advances in artificial intelligence, robotics and wearable computing are creating novel technological opportunities for mitigating the global burden of population ageing and improving the quality of care for older adults with dementia and/or age-related disability. Intelligent assistive technology is the umbrella term defining this ever-evolving spectrum of intelligent applications for the older and disabled population. However, the implementation of IATs has been observed to be sub-optimal due to a number of barriers in the translation of novel applications from the (...) designing labs to the bedside. Furthermore, since these technologies are designed to be used by vulnerable individuals with age- and multi-morbidity-related frailty and cognitive disability, they are perceived to raise important ethical challenges, especially when they involve machine intelligence, collect sensitive data or operate in close proximity to the human body. Thus, the goal of this paper is to explore and assess the ethical issues that professional stakeholders perceive in the development and use of IATs in elderly and dementia care. Methods We conducted a multi-site study involving semi-structured qualitative interviews with researchers and health professionals. We analyzed the interview data using a descriptive thematic analysis to inductively explore relevant ethical challenges. Results Our findings indicate that professional stakeholders find issues of patient autonomy and informed consent, quality of data management, distributive justice and human contact as ethical priorities. Divergences emerged in relation to how these ethical issues are interpreted, how conflicts between different ethical principles are resolved and what solutions should be implemented to overcome current challenges. Conclusions Our findings indicate a general agreement among professional stakeholders on the ethical promises and challenges raised by the use of IATs among older and disabled users. Yet, notable divergences persist regarding how these ethical challenges can be overcome and what strategies should be implemented for the safe and effective implementation of IATs. These findings provide technology developers with useful information about unmet ethical needs. Study results may guide policy makers with firsthand information from relevant stakeholders about possible solutions for ethically-aligned technology governance. (shrink)

The various problems associated with co-authorship of research articles have attracted much attention in recent years. We believe that this growing awareness is a very welcome development. However, we will argue that the particular and increasing importance of authorship and the harmful implications of current practices of research authorship for junior researchers have not been emphasised enough. We will use the case of our own research area to illustrate some of the pitfalls of current publishing practices—in particular, the impact on (...) the evaluation of one’s work in the area of employment or funding. Even where there are explicit guidelines, they are often disregarded. This disregard, which is often exemplified through the inflation of co-authorship in some research areas, may seem benign to some of us; but it is not. Attribution of co-authorship for reasons other than merit in relation to the publication misrepresents the work towards that publication, and generates unfair competition. We make a case for increasing awareness, for transparency and for more explicit guidelines and regulation of research co-authorship within and across research areas. We examine some of the most sensitive areas of concern and their implications for researchers, particularly junior ones, and we suggest several strategies for future action. (shrink)

In this paper I offer a close reading of Aristotle’s argument in the Nicomachean Ethics 3.5.1114a31–b25 and try to show that despite considerable interpretive difficulties, some clear structure can nevertheless be discerned. While Aristotle’s main concern in this passage is to refute the so-called asymmetry thesis – the thesis that virtue is voluntary, but vice is not – there is much more in it than just a dialectical encounter. Aristotle wants to respond to a more general objection, which has as (...) its target the voluntariness of both virtue and vice, and which is provoked by some of his ideas in EN 3.4 and 3.5. Further, I will try to show why Aristotle thinks that we are only co-causes of our dispositions. In my opinion, his reasons have nothing to do with compatibilist or incompatibilist considerations as they are commonly understood in modern philosophy. In particular, he does not want to argue that nature is aitios of our dispositions just as ourselves are. Rather, we are co-causes of our dispositions because we are causal origins of actions without which a certain good, which is the final cause of our actions and of our dispositions, cannot be achieved. Finally, I will try to show that Aristotle’s discussion implies that there is no more to the responsibility for dispositions than there is to the responsibility for actions. (shrink)

While much of the scholarly work on ethics relating to academic authorship examines the fair distribution of authorship credit, none has yet examined situations where a researcher contributes significantly to the project, but whose contributions do not make it into the final manuscript. Such a scenario is commonplace in collaborative research settings in many disciplines and may occur for a number of reasons, such as excluding research in order to provide the paper with a clearer focus, tell a particular story, (...) or exclude negative results that do not fit the hypothesis. Our concern in this paper is less about the reasons for including or excluding data from a paper and more about distributing credit in this type of scenario. In particular, we argue that the notion ‘substantial contribution’, which is part of the International Committee of Medical Journal Editors (ICMJE) authorship criteria, is ambiguous and that we should ask whether it concerns what ends up in the paper or what is a substantial contribution to the research process leading up to the paper. We then argue, based on the principles of fairness, due credit, and ensuring transparency and accountability in research, that the latter interpretation is more plausible from a research ethics point of view. We conclude that the ICMJE and other organizations interested in authorship and publication ethics should consider including guidance on authorship attribution in situations where researchers contribute significantly to the research process leading up to a specific paper, but where their contribution is finally omitted. (shrink)

The use of biotechnology in food productiongives rise to consumer concerns. The term ``consumerconcern'' is often used as a container notion. Itincludes concerns about food safety, environmental andanimal welfare consequences of food productionsystems, and intrinsic moral objections againstgenetic modification. In order to create clarity adistinction between three different kinds of consumerconcern is proposed. Consumer concerns can be seen assigns of loss of trust. Maintaining consumer trustasks for governmental action. Towards consumerconcerns, governments seem to have limitedpossibilities for public (...) policy. Under current WTOregulations designed to prevent trade disputes,governments can only limit their policies to 1) safetyregulation based upon sound scientific evidence and 2)the stimulation of a system of product labeling. Ananalysis of trust, however, can show that ifgovernments limit their efforts in this way, they willnot do enough to avoid the types of consumer concernsthat diminish trust. The establishment of a technicalbody for food safety – although perhaps necessary –is in itself not enough, because concerns that relatedirectly to food safety cannot be solved by ``pure''science alone. And labeling can only be a good way totake consumer concerns seriously if these concerns arerelated to consumer autonomy. For consumer concernsthat are linked to ideas about a good society,labeling can only provide a solution if it is seen asan addition to political action rather than as itssubstitution. Labeling can help consumers take uptheir political responsibility. As citizens, consumershave certain reasonable concerns that can justifiableinfluence the market. In a free-market society, theyare, as buyers, co-creators of the market, andsocietal steering is partly done by the market.Therefore, they need the information to co-create thatmarket. The basis of labeling in these cases, however,is not the good life of the individual but thepolitical responsibility people have in their role asparticipants in a free-market. Then, public concernsare taken seriously. Labeling in that case does nottake away the possibilities of reaching politicalgoals, but it adds a possibility. (shrink)